Legislation Allows Rhode Island Physical Therapists to Continue Ordering Radiographs

Background

Research has shown that Physical Therapists are able to safely and effectively order radiographs^1,2,3. Furthermore, the privilege to order radiographs enhances Physical Therapists’ ability to practice in a direct access fashion which contribute toward reduced healthcare utilization and cost^4,5,6, as well as better rehabilitation outcomes⁷. Another benefit of PTs ordering radiographs is improved access to care^8,9 which is especially important given the current nationwide physician shortage is projected to continue growing¹⁰.

Legislative Update

Based on legislation that was passed in 2021, and renewed in 2023, Rhode Island state law permits Physical Therapists to order radiographs, commonly referred to as x-ray imaging. While this is a great stride forward for Physical Therapy as a doctoring profession in the state of RI, this legislation is set to expire at the end of 2025. To justify continuation of this privilege the PT community needs to provide evidence of appropriate utilization, improved access to healthcare, and reduced healthcare spending. Please see the attached Imaging Bill Announcement for more information.

Highlights From the Legislation

http://webserver.rilin.state.ri.us/PublicLaws/law21/law21207.htm (2021)

http://webserver.rilin.state.ri.us/PublicLaws/law23/law23048.htm (2023)

• The new authority shall not include other methodologies such as computer topography scan, ultrasound, bone scan, magnetic resonance imaging (MRI), or positron emission tomography scan.
• All diagnostic imaging tests (radiographs) ordered by a physical therapist shall be reported by the physical therapist to the patient’s designated primary care physician of record within seven (7) days following receipt of the results. This reporting shall not be required if the patient does not have a primary care physician.
• Unless extended by the general assembly, physical therapists shall not be authorized to order diagnostic imaging as an authorized practice of physical therapy after December 31, 2025.

Invitation to Participate in Research Study

We are inviting all Rhode Island Physical Therapists to participate in an important research study that aims to provide evidence for continuation of radiograph ordering privileges. If you are new to ordering radiographs, or if you have already been ordering, there is still time to join the study! For more information please visit www.jenniferhurrell.com/research.html or email Dr. Jennifer Hurrell at jhurrell@bryant.edu.

Continuing Education Course

Although not required for ordering, a short course on the Basics of Musculoskeletal Radiology is available that presents the most recent criteria and evidence for referral and interpretation of radiological studies. Individuals who did not attend the course in 2022 will have another opportunity to attend this course in person on Saturday October 21, 2023. Register for this course.

Alternatively, an online version of the course is available at: https://riapta.com/Forms/Form.asp?FormID=50

References:

1.          Crowell MS, Dedekam EA, Johnson MR, Dembowski SC, Westrick RB, Goss DL. DIAGNOSTIC IMAGING IN A DIRECT-ACCESS SPORTS PHYSICAL THERAPY CLINIC: A 2-YEAR RETROSPECTIVE PRACTICE ANALYSIS. Int J Sports Phys Ther. 2016;11(5):708-717. http://www.ncbi.nlm.nih.gov/pubmed/27757283%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5046964.

2.          Crowell MS, Mason JS, McGinniss JH. Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study. Int J Sports Phys Ther. 2022;17(2):237-246. doi:10.26603/001c.31720

3.          Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis. Phys Ther. 2019;99(8):1020-1026. doi:10.1093/ptj/pzz015

4.          Garrity BM, McDonough CM, Ameli O, et al. Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New-Onset Low Back Pain. Phys Ther. 2020;100(1):107-115. doi:10.1093/ptj/pzz152

5.          Liu X, Hanney WJ, Masaracchio M, et al. Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Phys Ther. 2018;98(5):336-347. doi:10.1093/ptj/pzy023

6.          Mabry LM, Notestine JP, Moore JH, Bleakley CM, Taylor JB. Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study. Mil Med. 2020;185(1-2):E290-E297. doi:10.1093/milmed/usz176

7.          McGill T. Effectiveness of physical therapists serving as primary care musculoskeletal providers as compared to family practice providers in a deployed combat location: A retrospective medical chart review. Mil Med. 2013;178(10):1115-1120. doi:10.7205/MILMED-D-13-00066

8.          Peterson G, Portström M, Frick J. Extended roles in primary care when physiotherapist-initiated referral to X-ray can save time and reduce costs. Int J Qual Heal Care. 2021;33(3):1-6. doi:10.1093/intqhc/mzab122

9.          Matifat E, Méquignon M, Cunningham C, Blake C, Fennelly O, Desmeules F. Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review. Phys Ther. 2019;99(9):1150-1166. doi:10.1093/ptj/pzz082

10.        Zhang X, Lin D, Pforsich H, Lin VW. Physician workforce in the United States of America: Forecasting nationwide shortages. Hum Resour Health. 2020;18(1):1-9. doi:10.1186/s12960-020-0448-3 

Submitted by: Jennifer Hurrell, PT, MS, DHSc

8/7/23